Norwalk



TRAFFIC CALMING REQUEST FORM

Today’s Date ___________

The purpose of this form is to enable a neighborhood to request a traffic study in accordance with the City of Norwalk’s traffic calming program. The traffic calming program addresses traffic safety concerns, such as excessive vehicle speeds, cut-through traffic and accidents. If you have such a concern, please fill out and submit this form including as much detail as possible and attach the names, addresses and signatures representing 50% of the households for the street(s) requesting action. For larger areas, contact the Department of Public Works for a determination of the petition area.

After completing this form, please submit to:

City of Norwalk

Attn: Director of Public Works

125 East Ave.

Norwalk, CT 06856

(203) 854-7791

customerservice@

1. Name of Neighborhood or organized group name: _________________________________________

Contact Name: ______________________________

Address: ______________________________

City: ______________________________

State: ______________________________

Zip Code: ______________________________

Day Phone: ______________________________

E-mail Address: ______________________________

2. Please describe the traffic concerns of the neighborhood, including any safety issues. Use additional sheets as necessary.

3. Please describe the specific location of concern, as well as the limits of your neighborhood and/or of area of concern. A sketch may be included and attached to this sheet, as well as any particular traffic calming requests the neighborhood may have. Tier 1 measures must be considered before installing Tier 2 devices like traffic circles and speed humps.

4. Please provide the names and signatures of at least half of the households in the affected area who are requesting that a review of this neighborhood and location be performed for the Neighborhood Traffic Calming Program. Additional names are welcome and should be attached on an additional sheet. Please note the main contact person. Use additional sheets as necessary.

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For City use only

Date Received: ______________

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